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Library of Congress Cataloging-in-Publication Data Snell, Richard S. Clinical anatomy by regions / Richard S. Snell. - 9th ed. p. ; cm. Includes index. Library of Congress Cataloging-in-Publication Data Snell, Richard S. Clinical anatomy by regions / Richard S. Snell. – 9th ed. p. ; cm. Includes index. This article contains Snell's Clinical Anatomy 9th Edition PDF for free It's called the Snell's Clinical Anatomy by Regions 9th Edition.

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Snell Clinical Anatomy By Regions | Download Free Pdf. The study of the structure of Human and its parts is called human anatomy. 3 Bone Marking Example Linear elevation Snell clinical anatomy by regions . In this new edition, further efforts have been made to weed out. Snell's Clinical Anatomy by Regions 9th Edition. LibrarySUMS. Views. 2 years ago 9th edition / by Richard S. Snell. READ. Show more documents; Share.

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Lymphatic tissue is essential for the immunologic defenses of the body against bacteria and viruses. Lymphatic vessels are tubes that assist the cardio- vascular system in the removal of tissue fluid from the tissue spaces of the body; the vessels then return the fluid to the blood. The lymphatic system is essentially a The thoracic duct and right lymphatic duct and their main tributaries.

The areas of body drained into thoracic duct clear and right lymphatic duct black. General structure of a lymph node. Lymph vessels and nodes of the upper limb. Lymphatic vessels are found in all tissues and organs of the body except the central nervous system, the eyeball, the inter- nal ear, the epidermis of the skin, the cartilage, and the bone. Lymph is the name given to tissue fluid once it has entered a lymphatic vessel. Lymph capillaries are a net- work of fine vessels that drain lymph from the tissues.

The capillaries are in turn drained by small lymph vessels,which unite to form large lymph vessels. Lymph vessels have a beaded appearance because of the presence of numerous valves along their course. Before lymph is returned to the bloodstream, it passes through at least one lymph node and often through sev- eral.

The lymph vessels that carry lymph to a lymph node are referred to as afferent vessels see Fig. The lymph reaches the bloodstream at the root of the neck by large lymph vessels called the right lymphatic duct and the thoracic duct see Fig.

However, it is of vital importance to medical personnel, since lymph nodes may swell as the result of metastases, or primary tumor. For this reason, the lymphatic drainage of all major organs of the body, including the skin, should be known. A patient may complain of a swelling produced by the enlargement of a lymph node. A physician must know the areas of the body that drain lymph to a particular node if he or she is to be able to find the primary site of the disease.

Often, the patient ignores the primary disease, which may be a small, painless can- cer of the skin. Conversely, the patient may complain of a painful ulcer of the tongue, for example, and the physician must know the lymph drainage of the tongue to be able to determine whether the dis- ease has spread beyond the limits of the tongue.

Functionally, the nervous system can be further divided into the somatic nervous system, which controls voluntary activities, and the autonomic nervous system, which con- trols involuntary activities. The nervous system, together with the endocrine sys- tem, controls and integrates the activities of the different parts of the body.

Central Nervous System The central nervous system is composed of large numbers of nerve cells and their processes, supported by specialized tissue called neuroglia. Neuron is the term given to the nerve cell and all its processes. The nerve cell has two types of processes, called dendrites and an axon. Dendrites are the short processes of the cell body; the axon is the longest process of the cell body Fig. The interior of the central nervous system is organized into gray and white matter.

Gray matter consists of nerve cells embedded in neuroglia. White matter consists of nerve fibers axons embedded in neuroglia. Peripheral Nervous System The peripheral nervous system consists of the cranial and spinal nerves and their associated ganglia.

On dissection, the cranial and spinal nerves are seen as grayish white cords.

Index of /iran anatomy files/text/

They are made up of bundles of nerve fibers axons supported by delicate areolar tissue. Cranial Nerves There are 12 pairs of cranial nerves that leave the brain and pass through foramina in the skull.

All the nerves are dis- tributed in the head and neck except the Xth vagus , which also supplies structures in the thorax and abdomen. The cranial nerves are described in Chapter Spinal Nerves A total of 31 pairs of spinal nerves leave the spinal cord and pass through intervertebral foramina in the vertebral column Figs. The spinal nerves are named according to the region of the vertebral column with which they are associated: Note that there are eight cervical nerves and only seven cervical vertebrae and that there is one coccygeal nerve and four coccygeal vertebrae.

During development, the spinal cord grows in length more slowly than the vertebral column.

Snell's Clinical Anatomy by Regions 9th Edition

To accommodate for this disproportionate growth in length, the length of the roots increases progressively from above downward. Each spinal nerve is connected to the spinal cord by two roots: The anterior root consists of bundles of nerve fibers carrying nerve impulses away from the central nerv- ous system Fig.

Such nerve fibers are called efferent fibers. Those efferent fibers that go to skeletal muscle and cause them to contract are called motor fibers. Their cells of origin lie in the anterior gray horn of the spinal cord. The posterior root consists of bundles of nerve fibers that carry impulses to the central nervous system and are called afferent fibers see Fig. Because these fibers are concerned with conveying information about sensa- tions of touch, pain, temperature, and vibrations, they are called sensory fibers.

The cell bodies of these nerve fibers are situated in a swelling on the posterior root called the posterior root ganglion Figs. At each intervertebral foramen, the anterior and poste- rior roots unite to form a spinal nerve see Fig. Here, the motor and sensory fibers become mixed together, so that a spinal nerve is made up of a mixture of motor and sensory fibers see Fig. On emerging from the fora- men, the spinal nerve divides into a large anterior ramus and a smaller posterior ramus.

The posterior ramus passes posteriorly around the vertebral column to supply the mus- cles and skin of the back Figs. The anterior ramus continues anteriorly to supply the muscles and skin over the anterolateral body wall and all the muscles and skin of the limbs. Multipolar motor neuron with connector neuron synapsing with it. Section through thoracic segment of spinal cord with spinal roots and posterior root ganglion.

Cross section of thoracic segment of spinal cord showing roots, spinal nerve, and anterior and posterior rami and their branches. In addition to the anterior and posterior rami, spinal nerves give a small meningeal branch that supplies the vertebrae and the coverings of the spinal cord the menin- ges.

Thoracic spinal nerves also have branches, called rami communicantes, which are associated with the sympa- thetic part of the autonomic nervous system see below. Plexuses At the root of the limbs, the anterior rami join one another to form complicated nerve plexuses see Fig.

The cer- vical and brachial plexuses are found at the root of the upper limbs, and the lumbar and sacral plexuses are found at the root of the lower limbs. The classic division of the nervous system into central and peripheral parts is purely artificial and one of descrip- tive convenience because the processes of the neurons pass freely between the two.

For example, a motor neuron located in the anterior gray horn of the 1st thoracic segment of the spinal cord gives rise to an axon that passes through the anterior root of the 1st thoracic nerve Fig. To take another example, consider the sensation of touch felt on the lateral side of the little toe. This area The fine terminal branches of the sen- sory axon, called dendrites, leave the sensory organs of the skin and unite to form the axon of the sensory nerve.

The axon passes up the leg in the sural nerve see Fig. The central axon now enters the posterior white column of the spinal cord and passes up to the nucleus graci- lis in the medulla oblongata—a total distance of about 5 ft 1. Thus, a single neuron extends from the little toe to the inside of the skull.

Both these examples illustrate the great length of a single neuron. Autonomic Nervous System The autonomic nervous system is the part of the nervous sys- tem concerned with the innervation of involuntary structures such as the heart, smooth muscle, and glands throughout the body and is distributed throughout the central and peripheral nervous system. The autonomic system may be divided into two parts—the sympathetic and the parasympathetic—and both parts have afferent and efferent nerve fibers.

The activities of the sympathetic part of the autonomic system prepare the body for an emergency. Segmental Innervation of the Skin The area of skin supplied by a single spinal nerve, and therefore a single segment of the spinal cord, is called a dermatome. On the trunk, adjacent dermatomes overlap considerably; to produce a region of complete anesthesia, at least three contiguous spinal nerves must be sectioned.

Dermatomal charts for the anterior and posterior surfaces of the body are shown in Figures 1. In the limbs, arrangement of the dermatomes is more com- plicated because of the embryologic changes that take place as the limbs grow out from the body wall. A physician should have a working knowledge of the seg- mental dermatomal innervation of skin, because with the help of a pin or a piece of cotton he or she can determine whether the sensory function of a particular spinal nerve or segment of the spinal cord is functioning normally.

Segmental Innervation of Muscle Skeletal muscle also receives a segmental innervation. Most of these muscles are innervated by two, three, or four spinal nerves and therefore by the same number of segments of the spinal cord. To paralyze a muscle completely, it is thus necessary to section several spinal nerves or to destroy several segments of the spinal cord. Learning the segmental innervation of all the muscles of the body is an impossible task.

Nevertheless, the segmental innerva- tion of the following muscles should be known because they can be tested by eliciting simple muscle reflexes in the patient Fig.

Afferent neuron that extends from the little toe to the brain. Efferent neuron that extends from the anterior gray horn of the first thoracic seg- ment of spinal cord to the small muscle of the hand. The sympathetic part of the autonomic system brings about a redistribution of the blood so that it leaves the areas of the skin and intestine and becomes available to the brain, heart, and skeletal mus- cle. At the same time, it inhibits peristalsis of the intestinal tract and closes the sphincters.

The activities of the parasympathetic part of the auto- nomic system aim at conserving and restoring energy. They slow the heart rate, increase peristalsis of the intestine and glandular activity, and open the sphincters. Sympathetic System Efferent Fibers The gray matter of the spinal cord, from the 1st thoracic segment to the 2nd lumbar segment, possesses a lateral horn, or column, in which are located the cell bod- ies of the sympathetic connector neurons Fig. The myelinated axons of these cells leave the spinal cord in the anterior nerve roots and then pass via the white rami com- municantes to the paravertebral ganglia of the sympa- thetic trunk Figs.

The connector cell fibers are called preganglionic as they pass to a peripheral ganglion. Once the preganglionic fibers reach the ganglia in the sympathetic trunk, they may pass to the following destinations: They may terminate in the ganglion they have entered by synapsing with an excitor cell in the ganglion see Fig.

The axons of the excitor neurons leave the ganglion and are nonmyelinated. Those fibers entering the ganglia of the sympathetic trunk high up in the thorax may travel up in the sympa- thetic trunk to the ganglia in the cervical region, where they synapse with excitor cells Figs.

Here, again, the postganglionic nerve fibers leave the sympathetic trunk as gray rami communicantes, and most of them join the cervical spinal nerves. Many of the preganglionic fibers entering the lower part of the The postgan- glionic fibers leave the sympathetic trunk as gray rami communicantes that join the lumbar, sacral, and coccy- geal spinal nerves.

The preganglionic fibers may pass through the gan- glia on the thoracic part of the sympathetic trunk without synapsing. These myelinated fibers form the three splanchnic nerves see Fig. The greater splanchnic nerve arises from the 5th to 9th thoracic ganglia, pierces the diaphragm, and synapses with excitor cells in the ganglia of the celiac plexus. The lesser splanchnic nerve arises from the 10th and 11th ganglia, pierces the diaphragm, and synapses with excitor cells in the ganglia of the lower part of the celiac plexus.

Splanchnic nerves are therefore composed of preganglionic fibers. The postganglionic fibers arise from the excitor cells in the peripheral plexuses previously noted and are distrib- uted to the smooth muscle and glands of the viscera.

Human anatomy

A few preganglionic fibers traveling in the greater splanchnic nerve end directly on the cells of the supra- renal medulla. Sympathetic trunks are two ganglionated nerve trunks that extend the whole length of the vertebral column see Fig.

There are 3 ganglia in each trunk of the neck, The two trunks lie close to the vertebral column and end below by joining together to form a single ganglion, the ganglion impar. AfferentFibersTheafferentmyelinatednervefiberstravel from the viscera through the sympathetic ganglia without synapsing see Fig. They enter the spinal nerve via the white rami communicantes and reach their cell bodies in the posterior root ganglion of the corresponding spinal nerve. The central axons then enter the spinal cord and may form the afferent component of a local reflex arc.

Others may pass up to higher autonomic centers in the brain. Parasympathetic System Efferent Fibers The connector cells of this part of the sys- tem are located in the brain and the sacral segments of the spinal cord see Fig.

Those in the brain form parts of the nuclei of origin of cranial nerves III, VII, IX, and X, and the axons emerge from the brain contained in the cor- responding cranial nerves. The sacral connector cells are found in the gray matter of the 2nd, 3rd and 4th sacral segments of the cord. These cells are not sufficiently numerous to form a lateral gray horn, as do the sympathetic connector cells in the thora- columbar region.

The myelinated axons leave the spinal cord in the anterior nerve roots of the corresponding spi- nal nerves. They then leave the sacral nerves and form the pelvic splanchnic nerves. All the efferent fibers described so far are preganglionic, and they synapse with excitor cells in peripheral ganglia, which are usually situated close to the viscera they inner- vate. The cranial preganglionic fibers relay in the ciliary, pterygopalatine, submandibular, and otic ganglia see Fig.

The preganglionic fibers in the pelvic splanchnic nerves relay in ganglia in the hypogastric plexuses or in the walls of the viscera.

Characteristically, the postganglionic fibers are nonmyelinated and are relatively short compared with sympathetic postganglionic fibers. Afferent Fibers The afferent myelinated fibers travel from the viscera to their cell bodies located either in the sensory ganglia of the cranial nerves or in the posterior root ganglia of the sacrospinal nerves. The central axons then enter the central nervous system and take part in the formation of local reflex arcs or pass to higher centers of the autonomic nervous system.

The afferent component of the autonomic system is identical to the afferent component of somatic nerves and forms part of the general afferent segment of the entire nervous system.

The nerve endings in the autonomic affer- ent component may not be activated by such sensations as heat or touch but instead by stretch or lack of oxygen. Once the afferent fibers gain entrance to the spinal cord or brain, they are thought to travel alongside, or are mixed with, the somatic afferent fibers.

Mucous Membranes Mucousmembrane is the name given to the lining of organs or passages that communicate with the surface of the body. A mucous membrane consists essentially of a layer of epithelium supported by a layer of connective tissue,the lam- ina propria. Smooth muscle, called the muscularis mucosa, is sometimes present in the connective tissue.

A mucous membrane may or may not secrete mucus on its surface. Serous Membranes Serous membranes line the cavities of the trunk and are reflected onto the mobile viscera lying within these cavities Fig.

They consist of a smooth layer of mesothelium supported by a thin layer of connective tissue. The serous membrane lining the wall of the cavity is referred to as the parietal layer, and that covering the viscera is called the vis- ceral layer.

The narrow, slitlike interval that separates these layers forms the pleural,pericardial, and peritoneal cavities and contains a small amount of serous liquid,the serousexu- date. The serous exudate lubricates the surfaces of the mem- branes and allows the two layers to slide readily on each other. The mesenteries, omenta, and serous ligaments are described in other chapters of this book. The parietal layer of a serous membrane is developed from the somatopleure inner cell layer of mesoderm and is richly supplied by spinal nerves.

It is therefore sensitive to all com- mon sensations such as touch and pain. The visceral layer is developed from the splanchnopleure inner cell layer of mes- oderm and is supplied by autonomic nerves. It is insensitive to touch and temperature but very sensitive to stretch. Mucous and Serous Membranes and Inflammatory Disease Mucous and serous membranes are common sites for inflam- matory disease.

For example, rhinitis, or the common cold, is an inflammation of the nasal mucous membrane, and pleurisy is an inflammation of the visceral and parietal layers of the pleura.

For exam- ple, drugs can be administered to lower the blood pressure by blocking sympathetic nerve endings and causing vasodilata- tion of peripheral blood vessels. In patients with severe arte- rial disease affecting the main arteries of the lower limb, the limb can sometimes be saved by sectioning the sympathetic innervation to the blood vessels.

This produces a vasodilata- tion and enables an adequate amount of blood to flow through the collateral circulation, thus bypassing the obstruction. Preganglionic parasympathetic fibers are shown in solid blue; postganglionic parasympathetic fibers, in interrupted blue. Preganglionic sympathetic fibers are shown in solid red; postgan- glionic sympathetic fibers, in interrupted red.

Bone Bone is a living tissue capable of changing its structure as the result of the stresses to which it is subjected. Like other con- nective tissues, bone consists of cells, fibers, and matrix. It is hard because of the calcification of its extracellular matrix and possesses a degree of elasticity because of the presence of organic fibers. Bone has a protective function; the skull and vertebral column, for example, protect the brain and spinal cord from injury; the sternum and ribs protect the thoracic and upper abdominal viscera Fig.

It serves as a lever, as seen in the long bones of the limbs, and as an important storage area for calcium salts. It houses and protects within its cavities the delicate blood-forming bone marrow.

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Bone exists in two forms: Compact bone appears as a solid mass; cancellous bone consists of a branching network of trabeculae see Fig. The trabeculae are arranged in such a manner as to resist the stresses and strains to which the bone is exposed. Classification of Bones Bones may be classified regionally or according to their general shape. The regional classification is summarized in Table 1.

Bones are grouped as follows based on their general shape: Note that under normal conditions the pleural cavity is a slitlike space; the parietal and visceral layers of pleura are separated by a small amount of serous fluid. Anterior view. Lateral view.

Long Bones Long bones are found in the limbs e. Their length is greater than their breadth. They have a tubular shaft, the diaphysis, and usually an epiphysis at each end.

During the growing phase, the diaphysis is separated from the epi- physis by an epiphyseal cartilage. The part of the diaph- ysis that lies adjacent to the epiphyseal cartilage is called the metaphysis. The shaft has a central marrow cavity containing bone marrow. The outer part of the shaft is composed of compact bone that is covered by a connective tissue sheath, the periosteum. The ends of long bones are composed of cancellous bone surrounded by a thin layer of compact bone.

The articular surfaces of the ends of the bones are covered by hyaline cartilage. Short Bones Short bones are found in the hand and foot e. They are roughly cuboidal in shape and are composed of cancellous bone Long bone humerus.

Irregular bone calcaneum. Flat bone two parietal bones separated by the sagittal suture. Sesamoid bone patella. Note arrangement of trabecu- lae to act as struts to resist both compression and tension forces in the upper end of the femur.

Short bones are covered with periosteum, and the articular surfaces are covered by hyaline cartilage. Flat Bones Flat bones are found in the vault of the skull e. The scapulae, although irregular, are included in this group. Irregular Bones Irregular bones include those not assigned to the previous groups e. They are composed of a thin shell of com- pact bone with an interior made up of cancellous bone. Sesamoid Bones Sesamoid bones are small nodules of bone that are found in certain tendons where they rub over bony surfaces.

The greater part of a sesamoid bone is buried in the tendon, and the free surface is covered with cartilage. Deformity may be visible if the bone fragments have been displaced relative to each other. The degree of deformity and the directions taken by the bony fragments depend not only on the mechanism of injury but also on the pull of the muscles attached to the frag- ments.

Ligamentous attachments also influence the deformity. In certain situations—for example, the ilium—fractures result in no deformity because the inner and outer surfaces of the bone are splinted by the extensive origins of muscles.

In con- trast, a fracture of the neck of the femur produces consider- able displacement. The strong muscles of the thigh pull the distal fragment upward so that the leg is shortened. The very strong lateral rotators rotate the distal fragment laterally so that the foot points laterally. Fracture of a bone is accompanied by a considerable hemorrhage of blood between the bone ends and into the sur- rounding soft tissue. The blood vessels and the fibroblasts and osteoblasts from the periosteum and endosteum take part in the repair process.

Other examples are found in the tendons of the flexor pollicis brevis and flexor hallucis bre- vis.

The function of a sesamoid bone is to reduce friction on the tendon; it can also alter the direction of pull of a tendon. Surface Markings of Bones The surfaces of bones show various markings or irregu- larities.

Where bands of fascia, ligaments, tendons, or aponeuroses are attached to bone, the surface is raised or roughened. These roughenings are not present at birth. They appear at puberty and become progressively more obvious during adult life. In certain situations, the surface markings are large and are given special names. Some of the more important markings are summarized in Table 1. Bone Marrow Bone marrow occupies the marrow cavity in long and short bones and the interstices of the cancellous bone in flat and irregular bones.

At birth, the marrow of all the bones of the body is red and hematopoietic. This blood-forming activity gradually lessens with age, and the red marrow is replaced by yellow marrow.

At 7 years of age, yellow marrow begins to appear in the distal bones of the limbs. This replacement of marrow gradually moves proximally, so that by the time the person becomes an adult, red marrow is restricted to the bones of the skull, the vertebral column, the thoracic cage, the girdle bones, and the head of the humerus and femur.

All bone surfaces, other than the articulating surfaces, are covered by a thick layer of fibrous tissue called the peri- osteum. The periosteum has an abundant vascular supply, and the cells on its deeper surface are osteogenic. The peri- osteum is particularly well united to bone at sites where muscles, tendons, and ligaments are attached to bone. Radiographic Anatomy angle of m. Radiographic Anatomy dome of di.

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Radiographic Anatomy transverse. Surface Anatomy Fragments of a. Surface Anatomy joint. The ilia. Appendix Urinary System Reprodu. Snell's Clinical Anatomy by Regions 9th Edition. Snell READ. Short-link Link Embed. Share from cover. 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upper lobe obliq Page 69 and Surface Anatomy 57 The internal tho Page 71 and Basic Anatomy 61 laryngotracheal tu Page 75 and Basic Anatomy 63 trachea cervical d Page 77 and Basic Anatomy 65 diminished breath Page 79 and Basic Anatomy 67 trachea right prin Page 81 and Basic Anatomy 69 right subclavian v Page 83 and Basic Anatomy 71 upper lobe of left Page 85 and Basic Anatomy 73 horizontal fissure Page 87 and Basic Anatomy 75 right and left lun Page 89 and Basic Anatomy 77 expanding box buck Page 91 and Basic Anatomy 79 right common carot Page 93 and Basic Anatomy 81 ascending aorta ar Page 95 and Basic Anatomy 83 septum secundum se Page 97 and Basic Anatomy 85 The interior of th Page 99 and Basic Anatomy 87 right coronary art Page and Basic Anatomy 89 Arteriosclerotic d Page and Basic Anatomy 93 include large vent Page and Basic Anatomy 97 arch of aorta left Page and Basic Anatomy 99 At the root of the Page and Radiographic Anatomy right brac Page and Radiographic Anatomy right clav 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sacrum is usu Page and Basic Anatomy superior articula Page and Basic Anatomy posterior sacroil Page and Basic Anatomy posterior cutaneo Page and Basic Anatomy Anterior division Page and Surface Anatomy site of inguina Page and Surface Anatomy anterior abdomi Page and B 1 3 S Page and Basic Anatomy coil of ileum sig Page and Basic Anatomy to form the entod Page and Basic Anatomy distended and hyp Page and Basic Anatomy The sympathetic n Page and Basic Anatomy of the bladder s Page and Basic Anatomy is devoid of glan Page and Basic Anatomy external iliac ve Page and Basic Anatomy mesonephric duct Page and Basic Anatomy posterior abdomin Page and Basic Anatomy passes forward on Page and Basic Anatomy decidua basalis d Page and Basic Anatomy branches of umbil Page and Basic Anatomy bladder prostate Page and Basic Anatomy columnar epitheli Page and Basic Anatomy the inferior hypo Page and Basic Anatomy part of the levat Page and Basic Anatomy rectum levator an Page and Basic Anatomy fatty 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ne Page and Basic Anatomy acetabulum acetab Page and Basic Anatomy inguinal ligament Page and Basic Anatomy femoral nerve ili Page and Basic Anatomy rectus femoris va Page and Basic Anatomy posterior to it, Page and Basic Anatomy the pelvis and ac Page and Basic Anatomy cervical curve at Page and For example, the extensor tendon sheaths of the hand may become inflamed after excessive or unaccustomed use; an inflammation of the prepatellar bursa may occur as the result of trauma from repeated kneeling on a hard surface.

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